A.

DEFINITION
Tetanus is derived from the word eflex ( Greek ) which means stretching. Tetanus is an
acute toxemia caused by neurofoksin produced by Clostridium tetani which is characterized by
periodic muscle spasms and severe .
Tetanus is an infectious disease characterized by stiffness and muscle spasms, without
disturbance of consciousness, as a result of the toxin closteridium tetani bacteria. Neonatorim
Tetanus is an infectious disease caused by the bacteria , Clostridium tetani.
B. ETIOLOGY
The cause of neonatal tetanus is Clostridium tetani which is a gram- positive, anaerobic,
rod shape and slim. Germs are on the ground, the digestive tract of humans and animals. Germs
clostridium tetani spores are durable and produce two major toxins that tetanospasmin and
tetanolysin.
C. TRANSIMIS
Tetanus is not transmitted from person to person. The large or small wound is being the
entrance for tetanus bacteria ( Clostridium tetani ), as well as a place to grow and produce toxins.
Tetanus can follow elective surgery, burns, deep puncture wounds, crush injuries, otitis media,
dental infections, animal bites, abortion, and pregnancy . Heroin users, especially those who use
needles subcutaneously with quinine-cut heroin, have a high risk for tetanus. Quinine is used to
dilute heroin and actually be able to support the growth of the bacterium Clostridium tetani.
During 1998-2000, acute injury or injuries such as punctures, lacerations, and abrasions
accounted for 73 % of reported cases of tetanus in the US people who work in fields that have a
risk for punctured, cuts, and abrasions.
D. SIGNS SYMPTOMS
Clinical symptoms of neonatal tetanus are very typical that primitive society is able to
recognize it as "the eighth day of the disease" (Jaffari, Pandit and Ismail 1966). Children who

originally crying, sucking and normal life, began the third day showed clinical symptoms
ranging from stiffness and difficulty sucking mouth, risus sardonicus to opisthotonos. Trismus on
neonatal tetanus is not as clear as in patients with a child or adult, because the rigidity of the neck
muscles are stronger than the masseter muscle, so that the lower jaw and mouth precisely
interested rather open and stiff (Athvale, and Pai, 1965, Marshall, 1968). Notching mouth into
mecucu (Jw) as the mouth of carp. Babies who originally returned limp after a seizure is quickly
becoming more rigid and frequency of seizures become more frequent with the clinical signs of
respiratory failure (Irwantono, Ismudijanto and MF Kaspan 1987).
Stiffness at very specific tetanus: flexion of the hand, the extension of the legs but plantar
flexion of the toes are not as clear in people with children. Stiffness in the muscles begin local or
trismus then spread throughout the body, without disturbance of consciousness. The whole body
of the baby becomes stiff, bent (flexed) at the elbow with clenched hands loudly. Hipertoni
becomes higher, so that the baby can be lifted like a piece of wood. Stiff neck often causes the
head in the position of looking up
E. PREVENTION
A person who exposed to tetanus is not immune to replay attacks means that he has the
same chance to get tetanus when injury occurs just as other people who have never been in
immunization. No formation of immunity in patients after he recovered because the toxins into
the body is not able to stimulate the formation of antitoxin ( because tetanospamin very potent
and toxicity can be very fast, even in minimal concentrations, which it is not in adequate
concentrations to stimulate the formation of immunity).
Vaccination is the best prevention method against tetanus. Advisory Committee on
Immunization Practices (ACIP) recommends that all children receive a regular series of 5 doses
of diphtheria and tetanus vaccine at 2, 4, 6, 15-18 months, and 4-6 years. Booster doses of
diphtheria and tetanus toxoid should be given starting at age 11-12 years (at least 5 years since
the last dose) and repeated every 10 years thereafter. Currently, DTaP and DT should be used in
people less than seven years, while the Td for those aged seven years or more. Catch-up
immunization schedule Td for those starting at the age of seven years or more of three doses. The
second dose is usually given 1-2 months after the first dose and the third dose is given 6 months

after the second dose. Formulation acellular pertussis vaccine for adolescents and adults who are
licensed and in combination with diphtheria and tetanus toxoids-. Recommended schedule for
Tdap undetermined, but this vaccine must be received in proper condition.

F. TREATMENT
1. Antibiotics:
Administered parenterally Peniciline 1,2juta units / day for 10 days, IM. While tetanus in
children can be given a dose Peniciline 50,000 units / kg / 12 hours secafa IM
administered for 7-10 days. When sensitive to peniciline, the drug can be replaced with
other preparations such as tetracycline dose of 30-40 mg / kg / 24 hours, but dose not
exceed 2 grams and given in divided doses (4 doses). When available Peniciline
intravenously, can be used at a dose of 200,000 units / kg / 24 hours, 6 divided doses for
10 days. Antibiotics are only intended to kill the vegetative form of C.tetani, not to toxins
it produces. Where the presence of broad-spectrum antibiotics complications can be done
(1,8.10).
2. Antitoxin
Tetanus antitoxin can be used Human immunoglobulin (TIG) at a dose of 3000-6000 U,
one-time administration only, IM should not be administered intravenously as TIG
contains "anti-complementary aggregates of globulin", which can trigger serious allergic
reactions. When TIG does not exist, it is recommended to use a tetanus antitoxin, which
originated from animals, at a dose of 40,000 U, by way of administration is: 20,000 U of
antitoxin was added to 200 cc liquid physiological NaC1 and administered intravenously,
the provision should be completed within a 30- 45 minutes. The remaining half dose
(20,000 U) given IM in the outer regions. (1.8.9)
3. Tetanus toxoid
Giving Tetanus Toxoid (TT) first, conducted in conjunction with the administration of
antitoxin but on different sides with different syringes. Giving done I.M. Giving TT
should be continued until completion of basic immunization against tetanus

TETANUS
BY:
ARINIL CHAIRA
NIM PO7120413002

MINISTRY OF HEALTH OF THE REPUBLIC OF INDONESIA

POLYTECHNIC OF HEALTH MINISTRY OF HEALTH ACEH
STUDY D - IV NURSING
YEAR 2015